Compliance Manual Acknowledgement Form

Disclosures

This sample Compliance Manual Acknowledgement Form has not been customized to your investment adviser’s business model, the specific investment advisory rules of your investment adviser’s securities regulator or your investment adviser’s written supervisory procedures and code of ethics. This sample Compliance Manual Acknowledgement Form may not be applicable or appropriate for your investment adviser.

Due to changes of investment adviser laws and rules, this sample Compliance Manual Acknowledgement Form may become outdated and need to be updated or discontinued.

This sample Compliance Manual Acknowledgement Form is not a substitute for retaining a compliance professional to advise and assist you regarding your investment adviser’s compliance program.

Unless otherwise agreed to in writing, you understand that RIA Compliance Consultants, Inc. is not responsible for: customizing sample Compliance Manual Acknowledgement Form; implementing the use of this sample Compliance Manual Acknowledgement Form, updating this sample Compliance Manual Acknowledgement Form, preparing your investment adviser’s written supervisory procedures or code of ethics, or notifying you of changes to the investment advisor laws and rules.

I, ______, do hereby acknowledge and agree to the following:

1. I have read, carefully reviewed, participated in training relating to and understand (Firm Name)’s Investment Adviser Compliance Manual which includes (Firm Name)’s Code of Ethics and Insider Trading policies and procedures.

2. I agree to conduct business with the highest levels of ethical standards and agree to comply with all applicable federal and state securities laws at all times. Under the terms and conditions of my affiliation or employment with (Firm Name), I am required and agree to comply with all federal, state and self-regulatory organizations laws, rules, and regulations in addition to those established and imposed by (Firm Name).

3. I will implement the procedures and standards set forth in the Investment Adviser Compliance Manual in addition to any and all periodic updates to the best of my ability.

4. If I have been deemed an access person, I have disclosed to (Firm Name) the existence and location of all reportable securities in which I, my spouse, any of my minor children, any relatives living with me and any person to whom I contribute support, have or has any direct or indirect beneficial interest or over which I or any such person have or has any control or provides any investment advice, and I have disclosed to (Firm Name) all transactions in such accounts through the date of this Acknowledgment.

5. I will periodically review and update my knowledge of information contained in the Compliance Manual so that as an employee, affiliate, or investment adviser representative of (Firm Name), I will remain in compliance with all policies, procedures, rules and regulations contained in the manual.

6. I understand that any violation to policies, procedures, rules and regulations contained in the Compliance Manual might result in disciplinary actions being taken against me including, but not limited to, termination of my affiliation or employment with (Firm Name).

By signing below, I agree that I have read both this acknowledgement statement and the referenced Investment Adviser Compliance Manual in their entity. I understand the information contained within the Compliance Manual and agree to accept my responsibilities as an employee, affiliate or investment adviser representative of (Firm Name).

Signature: ______

Title:

______

ACCEPTED AND REVIEWED BY CHIEF COMPLIANCE OFFICER, (Chief Compliance Officer)

Signature of Chief Compliance Officer: ______

Date: ______